State officials have grown increasingly concerned about the facilities, with 89 investigations already underway.

The Hawaii Department of Health has issued a $51,000 fine to an unlicensed adult residential care home managed by Bella Ariota on Maui.

Among the concerns, state officials found 11 unrelated elderly residents paying an illicit fee to the home to receive unlicensed 24-hour living accommodations.

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Health department inspectors conducted an investigation into the Kahului home in November. The notice of violation was issued in April and the fine was based on $100 for each day the unlicensed facility was in operation, according to DOH.

Ariota said she was unaware her actions were illegal and would have appreciated some time from the government to register and license her home care. 

“Not everyone can afford to pay $7,000 to $8,000 per month at licensed facilities, and I do it for $3,000,” said Ariota.

State legislators and Gov. Josh Green have become increasingly concerned about these unlicensed care homes and their operations, with 89 investigations of such facilities already underway. The DOH said it can’t comment on cases under investigation.

But there are several cases where initial inspections on suspected care homes were rejected and investigators had to wait for search warrants. One example cited occurred last year at a suspected unlicensed adult residential care home in Pearl City on Oahu.

Those problems are compounded, legislators stated in Senate Bill 1378, by licensed care homes that continue to transfer overflow patients to these facilities.

The Legislature passed that bill this year and it is pending consideration by the governor. It prohibits all new referrals or transfers of patients to unlicensed care homes and repeals any landlord exclusions, which have been used to stymie investigations.

Elderly man walks with cane along Hotel Street in metropolitan Honolulu.
The problem of unlicensed care homes is becoming more acute as more older adults find themselves in need of care that can be prohibitively expensive. (Cory Lum/Civil Beat/2022)

A landlord exclusion in this instance enables the homes to refuse the inspectors entry by claiming rooms are being rented to tenants. DOH is not allowed to enter and investigate private properties until receiving search warrants issued by the court.

SB 1378 “expands the Department’s ability to protect our kupuna by making it easier to investigate and take appropriate enforcement action as necessary if someone is operating a care home without a license,” said Keith Ridley, chief of the state’s Office of Health Care Assurance.

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The U.S. Department of Health and Human Services and other federal agencies have been chronicling the rise of these unlicensed care homes and documenting the demand for them, including more patients who lack the funds to cover expenses for licensed facilities as well as the exclusionary policies licensed care homes have against admitting residents exhibiting substance use and behavior problems.

In turn, the report notes, the conditions of many unlicensed care homes are “abusive, financially exploitative and neglectful of residents’ basic needs.”


Critics of SB 1378 raised another concern, saying the bill would restrict elderly placement permissions and not allow relatives to care for their family members at their own homes

The DOH did not respond to a request to address what elderly patients should do if they cannot afford a licensed facility but still need help.

Ridley said that non-relatives paying a fee for the 24-hour accommodations help to create the health management problems. This bill, he added, “does not restrict anyone from receiving health care or other services in their own home or family members from caring for a relative.”

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